Cleft Care Companion: An innovative app to educate and connect patients with a cleft and their families to treatment centres

medical resources may be highly limited. Smile Train’s partner network of more than 1100 treatment centres in more than 70 countries has treated over 1.5 million cleft patients


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in LMICs free of charge [5,6].Early referral of babies with clefts to specialised CCC centres as close as possible to their homes is essential to avoid preventable morbidity and mortality and to ensure optimal treatment outcomes [7].While historical approaches of brochures, radio broadcasts, and clinician referrals have led to an increase in referrals and a decrease in age at referral, referral delays remain a concern, particularly in underserved or remote areas [8].In an effort to expand cleft awareness and education and improve equity of access to local Smile Train-affiliated centres providing free CCC, Smile Train leveraged technology to educate and link patients to treatment centres.The mobile application, Cleft Care Companion, was envisioned with the target audience of global non-governmental organisations (NGOs), health care workers, and government/public information teams working "in the field" in LMICs to be able to refer and connect patients to treatment centres.

IMPORTANCE OF COMMUNITY/SOCIAL WORKERS
In LMICs, the role of community health workers and social workers is essential to increasing access to basic and specialised health care [9,10].These workers are most often the principal health care contact in remote regions and carry a trusting relationship with the regions they serve.The expansion of technology and internet connectivity allows community and social workers to use mobile devices to assist with evaluations, communication, referrals, and even data collection, having been proven as an effective way to assist with job functions [11,12].For remote regions not covered by a larger hospital system, community health workers and social workers provide a crucial role in education, spreading awareness, and documenting the need for health care interventions.Mobile health apps have the potential to minimise and address inequalities in access to health care that are often experienced by families in remote or underserved areas.

CLEFT CARE COMPANION APP
Cleft Care Companion is a freely available app released in mid-2021 to be used as a tool to educate patients, their families, and health care workers while enabling rapid and effective patient referral to their local CCC centres for free treatment.Its target audience includes members of the health care community, social workers, community workers, government health care officials, and patients and their families.Cleft Care Companion is an up-to-date education tool providing essential information about clefts in lay language (Figure 1) and is available in English, Spanish, and French, with more languages to come.The app is built in 4 main sections: Information, Resources, Find, and Cases.
Application usage depends on the user, with the majority of users using the Information, Resources, and Find sections.The Information section answers frequently asked questions about clefts, displays treatment timelines and milestones for patients with clefts (Figure 1), shows actual patients (Figure 2), and provides information about Smile Train.A large

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portion of this information can be downloaded locally for offline display or sharing in the Resources section.In the Find section, Smile Train partners are listed on a world map (Figure 3), utilising location services to match a treatment centre closest to the user.CCC centres have their contact info and services offered displayed to help connect patients to their nearest centre.The Cases section is designed for health care, social, or community health workers to register cases within the Cleft Care Companion system.When a health care worker or an individual in the community encounters a person with a cleft needing help, they can register the case into the app by adding personal details, location, and a picture (Figure 4).Registered cases are contacted by Smile Train staff to provide assistance in receiving timely treatment from the nearest centre.
There are more than 320 unique users of Cleft Care Companion originating from the app's pilot phase.Since then, a total of 522 patient cases have been registered within Cleft Care Companion with an average of 208.8 cases registered per year, with the majority of cases being registered in the Sub-Saharan Africa region.Following upcoming awareness campaigns with community health workers and other health care professionals, these app usage metrics are expected to show an increase in app use.App metric data collection subsequently informs strategies for the distribution of the app as well as evaluating the impact of its use.

CONCLUSION
Improving equity of access to care involves not only the ongoing building of local clinical capacity, but also ensuring that patients, the public, and health care workers are aware of how and where to access such care.The Cleft Care Companion app was developed to meet these needs, being co-designed with input from health care and Smile Train staff representing 30 countries utilising their experiences of the challenges patients face in accessing care and their recognition of the need for accessible education.Continuing work includes application use analytics and translating the app further to expand the reach of CCC services and reduce the burden of clefts worldwide.Funding: The research presented in the manuscript received no external funding.
Authorship contributions: AS contributed to writing the manuscript and preparing the original draft.ER, GP, and FM contributed to writing, reviewing, and editing the manuscript.FM contributed to conceptualisation and supervision.All authors reviewed and approved the final version of the manuscript.

Disclosure of interest:
The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: FM is the chair of the Smile Train Research and Innovation Council; this is a volunteer position.AS is the Director of Research, Surgical Outcomes & Evaluation at Smile Train; this is a paid position.ER is Vice President of Smile Train Programs Data & Technology; this is a paid position.GP is the Programs Manager, USA and Europe at Smile Train; this is a paid position.There are no other disclosures to report.

Figure 1 .
Cleft Care Companion frequently asked questions.

Figure 3 .
Figure 3. Cleft Care Companion map view and location tool to identify a treatment centre.

Figure 4 .
Figure 4. Cleft Care Companion case registration for health care and community workers.